Interobserver Variability in the International Study Group for Pancreatic Surgery (ISGPS)-Defined Complications After Pancreatoduodenectomy
Annals of Surgery, vol. 280, pp. 728–733
Abstract
OBJECTIVE: To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others. BACKGROUND: Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and within centers. However, data on interobserver variability for pancreatoduodenectomy-specific complications are lacking. METHODS: International cross-sectional multicenter study including 52 raters from 13 high-volume pancreatic centers in 8 countries on 3 continents. Per center, 4 experienced raters scored 30 randomly selected patients after pancreatoduodenectomy. In addition, all raters scored 6 standardized case vignettes. This variability and the "within centers" variability were calculated for 2-fold scoring (no complication/grade A vs grade B/C) and 3-fold scoring (no complication/grade A vs grade B vs grade C) of postoperative pancreatic fistula, postpancreatoduodenectomy hemorrhage, chyle leak, bile leak, and delayed gastric emptying. Interobserver variability is presented with Gwet AC-1 measure for agreement. RESULTS: Overall, 390 patients after pancreatoduodenectomy were included. The overall agreement rate for the standardized cases vignettes for 2-fold scoring was 68% (95% CI: 55%-81%, AC1 score: moderate agreement), and for 3-fold scoring 55% (49%-62%, AC1 score: fair agreement). The mean "within centers" agreement for 2-fold scoring was 84% (80%-87%, AC1 score; substantial agreement). CONCLUSIONS: The interobserver variability for the ISGPS-defined complications of pancreatoduodenectomy was too high even though the "within centers" agreement was acceptable. Since these findings will decrease the quality and validity of clinical studies, ISGPS has started efforts aimed at reducing the interobserver variability.
Authors 32
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Tessa E. Hendriks corresponding Aachen Department of Surgery, Leiden University Medical Center Dutch Institute for Clinical Auditing
Leiden University Medical Center · Amsterdam UMC Location University of Amsterdam · Dutch Institute for Clinical Auditing · Cancer Center Amsterdam
Affiliation as printed
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam the Netherlands
Cancer Center Amsterdam, the Netherlands
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Dutch institute for Clinical Auditing, Leiden, the Netherlands
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
Department of surgery, Leiden University Medical Center, Leiden, the Netherlands
Dutch institute for Clinical Auditing, Leiden, The Netherlands
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Affiliation as printed
Unit of General and Pancreatic Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, The Pancreas Institute Verona, University of Verona, Verona, Italy
Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, University of Verona, Verona, Italy
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Susan van Dieren corresponding
Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam the Netherlands
Cancer Center Amsterdam, the Netherlands
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
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José Annelie Suurmeijer corresponding
Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam the Netherlands
Cancer Center Amsterdam, the Netherlands
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
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Affiliation as printed
Unit of General and Pancreatic Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, The Pancreas Institute Verona, University of Verona, Verona, Italy
Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, University of Verona, Verona, Italy
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Thomas F. Stoop corresponding
Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam · University of Colorado Anschutz
Affiliation as printed
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam the Netherlands
Cancer Center Amsterdam, the Netherlands
Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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University of Colorado Anschutz
Affiliation as printed
Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO
Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Department of surgery, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Department of surgery, Duke University, Durham, NC
Department of surgery, Duke University, Durham North Carolina USA
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Affiliation as printed
Department of surgery, Duke University, Durham, NC
Department of surgery, Duke University, Durham North Carolina USA
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Thilo Hackert corresponding
University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of General Visceral and Thoracic Surgery University Hospital Hamburg-Eppendorf, Germany
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Jakob Robert Izbicki corresponding
University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of General Visceral and Thoracic Surgery University Hospital Hamburg-Eppendorf, Germany
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NYU Langone Health · Cancer Center Amsterdam · New York University
Affiliation as printed
Department of Surgery, New York University Langone Health, New York, NY
Cancer Center Amsterdam, the Netherlands
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NYU Langone Health · Cancer Center Amsterdam · New York University
Affiliation as printed
Department of Surgery, New York University Langone Health, New York, NY
Cancer Center Amsterdam, the Netherlands
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Affiliation as printed
Department of surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Affiliation as printed
Department of surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Affiliation as printed
Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China
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Affiliation as printed
Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China
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University of Verona · Kyushu University
Affiliation as printed
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, University of Verona, Verona, Italy
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University of Verona · Kyushu University
Affiliation as printed
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, University of Verona, Verona, Italy
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Seoul National University · University of Colorado Anschutz
Affiliation as printed
Department of Surgery, Seoul National University Center, Seoul, Korea
Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Seoul National University · University of Colorado Anschutz
Affiliation as printed
Department of Surgery, Seoul National University Center, Seoul, Korea
Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Affiliation as printed
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Shailesh Vinayak Shrikhande corresponding
Tata Memorial Hospital · Amsterdam UMC Location University of Amsterdam
Affiliation as printed
Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
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Vikram Anil Chaudhari corresponding
Tata Memorial Hospital · Amsterdam UMC Location University of Amsterdam
Affiliation as printed
Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
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Olivier R. Busch corresponding
Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam the Netherlands
Cancer Center Amsterdam, the Netherlands
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
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Manchester Royal Infirmary · University of Manchester · Cancer Center Amsterdam
Affiliation as printed
Hepatobiliary and Pancreatic Surgery Unit, Manchester Royal Infirmary, Manchester University NHS FT, Manchester, United Kingdom
Cancer Center Amsterdam, the Netherlands
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Dutch Institute for Clinical Auditing · Medical University of Vienna
Affiliation as printed
Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
Dutch institute for Clinical Auditing, Leiden, The Netherlands
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich, Munich, Germany
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Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Department of surgery, Leiden University Medical Center, Leiden, the Netherlands
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University of Verona · University of Padua
Affiliation as printed
Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, University of Verona, Verona, Italy
Giovanni Marchegiani, Marc G Besselink Shared senior Authors
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Marc G. Besselink corresponding
Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam
Affiliation as printed
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam the Netherlands
Cancer Center Amsterdam, the Netherlands
Amsterdam UMC, location University of Amsterdam, Department of Surgery Amsterdam, the Netherlands
Giovanni Marchegiani, Marc G Besselink Shared senior Authors
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